Did you get any errors when building the page? It doesn't look like all the necessary included files are there - for example, if you're using SecurityAssist this file should be included:
<?php require_once( "webassist/security_assist/helper_php.php" ); ?>
Probably also the form validations files:
<?php require_once("webassist/form_validations/wavt_scripts_php.php"); ?>
<?php require_once("webassist/form_validations/wavt_validatedform_php.php"); ?>
Please add error reporting at the very beginning of the page then load the page in the browser and tell us what the error messages are:
<?php
error_reporting(E_ALL);
ini_set('display_errors','on');
?>
